NR341 Exam 1 Concept Review PDF

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NR341: Exam 1 Concept Review -- 60 questions Chapters for this exam 11th edition Chapter 65: Critical Care, pages 1533-1536 (Overview of Critical Care) Chapter 9: Palliative Care at the end of Life Chapter 18: Intraoperative Care, pages 322-324 Table 18-6 and 18-7 (Opioids, Benzodiazepines, Neuromuscular Blocking Agents, Dexmedetomidine, Propofol) Chapter 16: Fluid, Electrolyte, and Acid-Base Imbalances pages 286-291. Chapter 26: Upper Respiratory Problems,pages 485-490 Chapter 65: Critical Care, pages 1547-1563 Beginning with Non-invasive ventilation. Chapter 67: Acute Respiratory Failure and Acute Respiratory Distress Syndrome, pages 1588-1603 Chapter 33: Coronary Artery Disease and Acute Coronary Syndrome Chapter 34: Heart Failure Chapter 35: Dysrhythmias ⭐MEDS Pain Medications and reversal agents ● For opioid analgesics the antidote for overdose is nalaxone (Narcan) ● Morphine ○ Reversal agent: Narcan (naloxone) ■ Narcan half-life is shorter than morphine ■ Wears off before morphine ■ Must reassess patient RR ○ Side effects ■ Drowsiness, dizziness, constipation ○ Adverse effect ■ Hypotension, bradycardia, and respiratory depression ○ Nursing interventions ■ reassess : IV 5-15 min, PO 30-45 min, IM 15-30 min ○ Education ■ 1.Change position slowly ■ 2.Use the call light, do not try to get out of bed without help. ■ 3.What for nausea and vomiting--antiemetics (ondansetron) ■ 4.May cause itching, call immediately if rash develops or throat starts swelling. ■ 5. May cause constipation (increase fluids and fiber, stool softener)

● Benzodiazepines

○ Sedative -- NO ANALGESIC EFFECTS ○ Used for ventilator/anesthesia adjunct ○ AE: Monitor for respiratory depression ○ Reversal: flumazenil (Romazicon) ● Propofol (Diprivan) - non barbiturate hypnotic ○ Reversal agent: NONE ○ Sedative -- NO ANALGESIC EFFECTS ○ Used for ventilator/anesthesia adjunct ○ Very short half life ○ AE: ■ Resp depression (pt must be on ventilator or have someone in the room who can intubate) ■ Severe hypotension ■ CNS depression ■ Hyperlipidemia ■ Infection risk (tubing changed q12h) ○ Interventions ■ MAINTAIN PATENT AIRWAY ● Dexmedetomidine (Precedex) -sedative ○ Antidote: Atipamezole ○ Adverse Effects: Hypotension, Nausea, Bradycardia ○ Should be used for no longer than 24 hours. Monitor HR, Liver, and Renal function. ○ No respiratory depression and anti-anxiety, can be used prior to surgery. ○ Analgesic and hypnotic, patient semi-arousable. ○ Rebound hypertension.

Drugs to know: (therapeutic effects, adverse effects) -- WHEN THE QUESTION ASKS WHAT THE

MED IS FOR REMEMBER TO READ THE SCENARIO CAREFULLY -- SOME MEDS ARE GENERALLY KNOWN TO DO 1 THING BUT CAN DO SOMETHING ELSE PERTAINING TO THE SITUATION ● Dopamine ○ Inotropic, vasopressor ○ Therapeutic effect: increase BP, HR, cardiac output ○ ADVERSE EFFECTS ■ CNS: Headache, anxiety ■ CV: Palpitations, tachycardia, hypertension, ectopic beats, angina, wide QRS complex, peripheral vasoconstriction, hypotension ■ GI: Nausea, vomiting, diarrhea ■ INTEG: Necrosis, tissue sloughing with extravasation, gangrene ■ RESP:Dyspnea ● Nitroglycerin ○ Nitrate ○ Treat or prevent angina (chest pain) -- caused by vasoconstriction of coronary arteries ○ Causes vasodilation in coronary arteries ■ SE: headache, orthostatic hypotension ○ 3 nitro 5 min in between SUBLINGUAL (Nitrostat) ■ Call 911 during 2nd nitro ○ Do not give with viagara (this drug causes vasodilation as well) -- if taken together will be fatal ○ ADVERSE EFFECTS ■ CNS: Headache, flushing, dizziness ■ CV: Postural hypotension, tachycardia, collapse, syncope, palpitations ■ GI: Nausea, vomiting ■ INTEG: Pallor, sweating, rash ● Atropine--antidysrhythmic ○ Blocks acetylcholine → increase cardiac output & HR by blocking vagal stimulation to the heart ■ Increase HR in sinus bradycardia < 40-50* ○ Anticholinergic -- Dry up secretions ○ ADVERSE EFFECTS ■ CNS: Headache, dizziness, involuntary movement, confusion, psychosis, anxiety, coma, flushing, drowsiness, insomnia, weakness, delirium (geriatric) ■ CV: Hypo/hypertension, paradoxical bradycardia, angina, PVCs, tachycardia, ectopic ventricular beats, bradycardia, palpitations ■ EENT: Blurred vision, photophobia, glaucoma, eye pain, pupil dilatation, nasal congestion, increased intraoccular pressure ■ GI: Dry mouth, nausea, vomiting, abdominal pain, anorexia, constipation, paralytic ileus, abdominal distention, altered taste ■ GU: Retention, hesitancy, impotence, dysuria ■ INTEG: Rash, urticaria, contact dermatitis, dry skin, flushing

■ MISC: Suppression of breastfeeding, decreased sweating, anaphylaxis ● Epinephrine ○ Vasoconstrictor, cardiac stimulator (helps to start the heart back up) ○ For lethal rhythms--asystole, vfib, vtach, PEA ○ Flush 20 cc saline and lift up arm to get circulation going ○ Give q3-5 min ○ ADVERSE EFFECTS ■ CNS: Tremors, anxiety, insomnia, headache, dizziness, weakness, drowsiness, confusion, hallucinations, cerebral hemorrhage ■ CV: Palpitations, tachycardia, hypertension, dysrhythmias, increased T wave ■ GI: Anorexia, nausea, vomiting ■ MISC:Sweating, dry eyes ■ RESP:Dyspnea, paradoxical bronchospasm (inhalation) ■ META: Hypoglycemia ● Lidocaine ○ Analgesic -- local ■ Patch ■ Injection*** ○ Treat ventricular dysrhythmias -- antiarrhythmic* -- decrease rate of contractions ■ Increases electrical stimulation threshold of ventricle and His-Purkinje system, which stabilizes cardiac membrane and decreases automaticity ○ ADVERSE EFFECTS ■ CNS: Headache, dizziness, involuntary movement, confusion, tremor, drowsiness, euphoria, seizures, shivering ■ CV: Hypotension, bradycardia, heart block, cardiovascular collapse, arrest ■ EENT: Tinnitus, blurred vision ■ GI: Nausea, vomiting, anorexia ■ HEMA: Methemoglobinemia ■ INTEG: Rash, urticaria, edema, swelling, petechiae, pruritus ■ MISC: Febrile response, phlebitis at inj site ■ RESP: Dyspnea, respiratory depression ● Beta Blockers ○ Antihypertensive and antianginal ■ Decrease workload of heart ○ Decrease BP and HR!!!!!!!! ■ Hypotension ■ Bradycardia ○ Monitor HR (...